Removal of tonsils in chronic tonsillitis: reviews, methods, consequences
The content of the article:
- Indications and contraindications for tonsillectomy
- Tonsillectomy methods
- The consequences of removing tonsils in chronic tonsillitis
- Video
Removal of tonsils in chronic tonsillitis, according to reviews and the results of numerous studies, is a safe and common operation in children and adults.
The method of removing tonsils is determined by the doctor
Chronic inflammation of the palatine tonsils occupies an important place in the structure of pathology, as a disease leading to inhibition of the natural defenses of the body. Long-term exposure to the pathological process can result in rheumatic lesions of the heart and joints, acute rheumatic fever or glomerulonephritis. Therefore, an individual approach to the choice of treatment tactics and a timely decision on surgical intervention are very important.
A symptom of chronic tonsillitis is prolonged subfebrile body temperature (37.1–38.0 ° C), especially in the evening, impaired appetite, irritability, relapses of sore throats almost every month. Other manifestations of the disease: paratonsillar abscess, cervical lymphadenitis, otitis media, unpleasant (putrid) breath, dermatoses.
Indications and contraindications for tonsillectomy
Removal of tonsils in chronic tonsillitis in adults is carried out according to the indications:
- frequent relapses of angina, accompanied by severe intoxication or prolonged subfebrile body temperature;
- ineffectiveness of conservative therapy;
- decompensated form of chronic tonsillitis;
- toxic-allergic form of tonsillitis II degree;
- tonsillogenic sepsis;
- swelling of the tonsil;
- tonsil tuberculosis;
- violation of swallowing or breathing due to an increase in the lymphoid tissue of the tonsils;
- purulent complications of the disease: paratonsillar or pharyngeal abscess, parapharyngeal phlegmon;
- thyrotoxicosis in patients with chronic tonsillitis.
Contraindications to tonsillectomy are:
- diseases of the blood system, including hemophilia, hemorrhagic diathesis, agranulocytosis, leukemia, etc.;
- decompensated conditions in systemic diseases: diabetes mellitus, heart, renal or respiratory failure;
- vascular anomalies of the pharynx: aneurysm, submucosal pulsation of the vessel;
- high degree of hypertension with the possible development of vascular crises;
- active form of tuberculosis;
- cirrhosis of the liver;
- severe neuropsychiatric diseases.
Diabetes mellitus is not a contraindication to tonsillectomy in the absence of ketone bodies in the urine. Surgical intervention is performed against the background of antibiotics, hemostatic agents and insulin preparations.
For patients with tuberculosis, tonsils are removed during anti-tuberculosis treatment during the period of stabilization of the tuberculosis process, after resorption of fresh foci.
In case of hypertension, the operation is performed against the background of the use of antihypertensive drugs.
In patients with rheumatism, tonsillectomy is indicated after a course of treatment, in the inactive phase of the disease.
A temporary contraindication to the intervention is dental caries, acute inflammatory or purulent diseases of the oral cavity, menstruation.
Tonsillectomy methods
Surgery is performed under general or local anesthesia. Preparation includes examination of the therapist, clinical blood test, general urine analysis, blood for HIV, syphilis, hepatitis B and C, hemostasiogram, biochemical blood test, bacteriological culture from the oropharynx, chest x-ray, ECG (electrocardiogram).
The operation can be performed both under local anesthesia and under general anesthesia
Surgical treatments for chronic tonsillitis include traditional and modern methods of removing the tonsils along with the adjacent capsule.
A traditional operation is performed using a scalpel. After the tonsils are husked, sutures are applied to the bleeding vessels.
After removing the tonsils, sutures are applied to the bleeding vessels
A relatively new method of radical removal of tonsils is coblation. This method is a variation of bipolar electrosurgery at lower temperatures (40 to 70 ° C). This minimizes thermal damage to the surrounding tissues, which significantly reduces the severity of postoperative pain with minimal bleeding.
A new technique for removing palatine tonsils is the use of a harmonic scalpel that vibrates at a certain frequency and contracts the underlying tissue with the release of thermal energy, which determines the coagulation effect.
Laser technologies are used as scalpel and coagulator. The use of a CO2 laser is a promising method, but has a limited range of actions.
Holmium laser is widely used. Its beam exits at the end of a thin silica fiber. During the pulsed propagation of radiation in water, its rapid evaporation occurs directly at the distal end of the optical fiber. Coagulation is carried out by twisting the vessels.
The laser gland removal process includes the following steps:
- laser vaporization in the area of the upper pole of the tonsil;
- excision of the scar with a laser beam;
- exfoliation of the palatine tonsil;
- cutting off the palatine tonsil with a tonsillitis loop.
Within a few days after the operation, the niches are evenly covered with fibrinous plaque.
The consequences of removing tonsils in chronic tonsillitis
Complications of tonsillectomy can be bleeding, infection, tongue edema, glossopharyngeal nerve injury. In rare cases, subcutaneous emphysema of the face, neck, pneumomediastinum, and pneumothorax are possible.
To avoid the development of complications, hemostatic and antibacterial therapy is carried out in the postoperative period.
To prevent secondary bacterial complications and the development of subcutaneous emphysema, the injured tissue is sutured during the operation.
In the postoperative period, situations involving an increase in pressure in the upper respiratory tract should be avoided, including coughing, voluntary neck muscle tension, sneezing, vomiting, as well as vigorous physical activity.
Bed rest, restriction of food intake is recommended. As a rule, on the first day there is an increased saliva production. In this case, it is necessary to breathe through the mouth and try not to swallow saliva.
After the operation, sedatives and, if indicated, antitussive drugs are prescribed. Broad-spectrum antibacterial drugs (Amoxicillin, Amoxiclav) can be used.
Thanks to adequate postoperative treatment, including antibiotic therapy, it is possible to significantly shorten the rehabilitation period and speed up the return to the usual way of life.
If there is a history of paratonsillar abscesses or multiple tonsillitis, it is necessary to take into account the greater likelihood of adhesion between the palatine tonsils and the amygdala, which increases the risk of bleeding during or after surgery.
Minor bleeding in the postoperative period can be stopped by injecting the bleeding area with anesthetic. Also, a tampon or gauze napkin soaked in a hemostatic agent is introduced into the tonsillar niche.
Hemostatic therapy is carried out with a solution of aminocaproic acid, 10% solution of calcium chloride or gluconate, drugs Dicinon or Tranexam.
The general condition of patients, quality of life, as well as most complications in the postoperative period are directly related to pain syndrome. Therefore, it is very important to control pain.
In the postoperative period, local nonsteroidal anti-inflammatory drugs are often prescribed
Pain syndrome after removal of tonsils is a consequence of inflammatory reactions, irritation of nerve endings, edema, muscle spasm in the pharyngeal region. To relieve inflammation and provide a decongestant and analgesic effect after surgery, non-steroidal anti-inflammatory drugs are used, mainly in the form of tablets for resorption (drugs based on flurbiprofen). Strepsils plus is often prescribed. It contains a combination of three components: a highly effective anesthetic (lidocaine hydrochloride) and two broad-spectrum antiseptics.
Surgical treatment of chronic tonsillitis has a positive effect not only on physical health, but also on psychological well-being.
Patients with chronic tonsillitis, who previously complained of loss of appetite, rapid fatigue, sensation of a foreign body in the throat, cervical lymphadenitis and pain in the joints, after removal of the palatine tonsils, notice an improvement in their well-being.
The optimal choice of the method of tonsillectomy, an individual approach to the management of the postoperative period and the fulfillment of all appointments prescribed by the doctor are the main components of a speedy recovery after removal of the palatine tonsils.
Video
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Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
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